P1153: UTILITY OF THE FRAILTY SCORE FOR PREDICTING PROGNOSIS AND INDIVIDUALIZING TREATMENT INTENSITY IN ELDERLY PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA
Authors: Yu Yagi, Yusuke Kanemasa, Yuki Sasaki, Kento Ishimine, Yudai Hayashi, Mano Mino, An Ohigashi, Yuka Morita, Taichi Tamura, Shohei Nakamura, Toshihiro Okuya, Tatsu Shimoyama
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype and is diagnosed at the median age of 70 years. Despite the development of anti-CD20 antibody treatment for combined use with chemotherapy, the prognosis of elderly patients with DLBCL remains poorer than that of younger patients. It is assumed that some elderly patients are too frail to receive standard chemotherapy because they are particularly susceptible to comorbidities and physiological organ function impairment. Actually, full-dose R-CHOP is not necessarily superior to attenuated R-CHOP in elderly patients probably because of treatment-related mortality (TRM). Meanwhile, inferior outcomes in older patients might be associated with undertreatment due to fears of severe side-effects. Thus, individualizing the treatment intensity for each patient is critical in elderly patients. Geriatric assessment (GA) tools such as these are helpful for predicting prognosis and toxicity in elderly patients. However, only a few, non-randomized studies have prospectively examined the clinical utility of GA tools, and guiding treatment decisions using them is not yet widely accepted in routine practice. Aims: The present study retrospectively evaluated the accuracy of the frailty score and TRM in predicting survival outcomes in patients with DLBCL aged ≥ 70 years. In addition, the impact of the frailty score on individual patient’s treatment intensity was assessed using Cox proportional-hazards modeling with restricted cubic spline (RCS). Methods: The present, retrospective, monocentric study analyzed patients aged ≥ 70 years who were newly diagnosed with DLBCL and received chemotherapy between 2004 and 2022. Survival outcomes and treatment-related mortality (TRM) were stratified according to geriatric assessment variables, and the influence of chemotherapy dose intensity on outcomes was assessed using the frailty score with a Cox hazards model with RCS in patients aged 70–79 years. Results: In total, 337 patients meeting the criteria described above were included in the analysis. Their median age was 77 years (range: 70–97 years), and the median follow-up period in surviving patients was 5.1 years (range: 0.12–16.4 years). Table 1 shows the baseline characteristics of the patients divided by age (70–79 and ≥ 80 years). The patients were classified as fit (n = 129, 38.3%), unfit (n = 141, 41.8%) or frail (n = 67, 19.9%) according to their frailty score. The frailty score accurately predicted prognosis (five-year overall survival [OS]: 73.1%, 60.2%, and 29.7% in fit, unfit, and frail patients, respectively. P < 0.001) and TRM (five-year TRM: 0%, 5.4%, and 16.8 in fit, unfit, and frail patients, respectively. P < 0.001) (Figure 1). Cox regression with RCS demonstrated a linear association between dose intensity and survival outcomes. Initial dose intensity (IDI) and relative dose intensity (RDI) had a significant impact on OS in fit patients (P for the effect of IDI on OS = 0.009, P for the effect of RDI on OS = 0.015). However, IDI and RDI had no significant effect on survival in non-fit (unfit and frail) patients (P for the effect of IDI on OS = 0.14, P for the effect of RDI on OS = 0.38) (Figure 2). Summary/Conclusion: The frailty score identified non-fit patients with poorer survival and a higher risk of TRM. While fit patients were likely to benefit from full-dose R-CHOP, unfit and frail patients would likely benefit more from attenuated R-CHOP. This study suggested a potential role for the frailty score in individualizing treatment intensity in elderly patients with DLBCL.Keywords: DLBCL